Typical exam stem
A patient with diabetes presents with vomiting, abdominal pain, dehydration and deep breathing. How would you confirm and manage DKA?
Active exam mode
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1. Sixty-second answer plan
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2. Section checklist
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3. Exam-pearl flashcards
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4. Viva drill
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What biochemical features define DKA?
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Recognise the metabolic emergency
DKA is characterised by hyperglycaemia or known diabetes, ketonaemia and metabolic acidosis. Glucose may be less striking than expected in some settings, including pregnancy or use of SGLT2 inhibitors, so do not exclude DKA solely because glucose is not extremely high.
Typical features include polyuria, polydipsia, vomiting, abdominal pain, dehydration, tachycardia, Kussmaul respiration and altered mental state in severe cases.
Initial investigations
- Bedside glucose and blood ketones where available.
- Venous or arterial blood gas for pH and bicarbonate.
- Electrolytes and renal function, with attention to potassium and calculated anion gap.
- ECG when potassium disturbance is possible.
- Search for the trigger: infection, missed insulin, myocardial infarction, stroke, pancreatitis, medications or a new diagnosis of diabetes.
Management priorities
Management combines fluid replacement, insulin, potassium management and treatment of the precipitating cause. Potassium can fall rapidly once insulin is started, so serial potassium measurement is essential. Insulin should not be viewed in isolation; successful treatment depends on coordinated correction of volume depletion and electrolytes.
Monitor clinical status, glucose, ketones, electrolytes, bicarbonate or pH and fluid balance. Resolution is based on correction of ketoacidosis rather than glucose normalisation alone.
Complications to anticipate
- Hypoglycaemia and hypokalaemia during treatment.
- Fluid overload in patients with cardiac or renal disease.
- Cerebral oedema, especially in younger patients, although uncommon in adults.
- Persistent acidosis from an unrecognised trigger, inadequate insulin delivery or another acid-base disorder.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.